DVT, PE, FES Flashcards
DVT, what is it
Deep vein thrombosis
+ blood clot formation – thrombus – in deep veins
+ usually in the legs
+ calves, thighs, pelvis
Pathophysiology of DVT
+ Clot formation: aggregates of platelets/fibrin/other cells + attached to the wall, including vein
+ blood flow stops
What is a PE
Pulmonary embolism
+ obstruction in pulmonary artery or smaller branch
What is the pathophysiology of a PE
+ Fragment of DVT that is pushed into a pulmonary vein or branch
+ air emboli
+ fat emboli
+ amniotic fluid
+ septic emboli – bacterial invasion of thrombus
What is FES
Fat embolism syndrome
+ fat particles that travel through circulation and large and a blood vessel
+ fat embolism causing multi system dysfunction – lungs, then brain, heart, kidneys, skin
What is the pathophysiology of FES
And 90% of cases: fracture or injury in long bone (femur)
+ widespread trauma, disease altering lipid metabolism
+ lipid transfusion
Risk factors of DVT
VIRCHOW’S TRIAD:
1. Venous status
2. Vessel wall injury
3. Altered hemoglobin coagulation (see all below, they all fit into triad)
+ age - over 60
+ genetics
+ inactive lifestyle
+ smoking
+ Pregnancy
+ heart disease
+ Obesity
+ hormonal changes
+ cancer
+ being sedentary
Diagnostic steps for DVT
+ Duplex ultrasound!
+ MRI
+ D dimer blood test
+ contrast venography
+ physical exam of limbs
+ labs: PT, PTT, INR
Treatments for DVT
+ Anticoagulant therapy – if not contra indicated
+ vitamin K antagonists
Common site of pulmonary embolism – PE
Outflow tract of main pulmonary artery
Complications of PE
Massive PE equals death within one hour!!
+ Increased pulmonary vascular resistance
+ increased pulmonary arterial pressure
+ decreased cardiac output
+ right ventricle failure
+ shock
Signs and symptoms of PE
+ Shortness of breath!
+ Rapid pulse/tachycardia
+ excessive sweating, anxiety
+ sharp chest pain - worse with deep breaths
+ coughing blood
+ hypotension
+ dizziness, syncope, fainting
Medical diagnostics for PE and treatments
DIAGNOSTICS:
+ Duplex ultrasound
+ MRI
+ D dimer blood test
THERAPIES:
+ anticoagulant therapy
+ aspirin
+ thrombotic agents
+ surgical procedures
Nursing interventions for DVT and PE to prevent
+ Early ambulation
+ leg exercises
+ repositioning body
+ graduated compression stockings
+ intermittent pneumatic compression devices
+ assess risks
+ lifestyle changes
Prevalence of PE with people who have DVT
30%!!!!
